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NR 547/ NR547 MIDTERM EXAM DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH GUIDE|
QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS) (NEW 2025/ 2026 UPDATE) -
CHAMBERLAIN
Comprehensive Metabolic Panel (CMP) - ANS ✓The CMP is another common blood test
used to determine general health status. The CMP includes several tests that provide
information about fluid and electrolyte balance as well as the status of the body's metabolism,
liver function, and kidney function. In psychiatric care, the CMP may be used to rule out
medical conditions that could cause symptoms such as changes in mood or cognition. The
CMP is also used to monitor the effects of medications, such as antipsychotics, on liver
function and glucose levels.
Normal CMP Levels
Electrolytes
Sodium (Na+):
Postassium (K+):
Chloride (Cl-):
Bicarbonate (HCO3-): - ANS ✓Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Normal CMP levels
Misc.
Calcium, serum (Ca 2+)
Glucose, serum Fasting:
2-h postprandial:
Cholesterol, serum:
Total Protein
Albumin - ANS ✓Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl;
2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
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Kidney Tests
Creatinine, serum
Urea nitrogen, serum (BUN) - ANS ✓Creatinine, serum 0.6-1.2mg/dl
Urea nitrogen, serum (BUN) 7-18mg/dl
Liver Tests
Alanine aminotransferase (ALT), serum:
Aspartate aminotransferase (AST),
Bilirubin, serum (adult) Total//Direct:
Phosphatase (alkaline), serum: - ANS ✓Liver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
Phosphatase (alkaline), serum: 20-70 U/L
Normal TFT levels
TSH:
T3:
T4: - ANS ✓Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Vitamin B12 Level - ANS ✓Providers may choose to check vitamin B12 levels. Deficiency
of vitamin B12 can affect mood and other brain functions. Common psychiatric symptoms
associated with B12 deficiency include depression, mania, psychotic symptoms, and
cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL
indicates a borderline level with a possible need for additional testing.
Vitamin D Level - ANS ✓Vitamin D affects functions such as neurotransmission,
neuroprotection, and neuroimmunomodulation. Studies have indicated a high prevalence of
vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression,
seasonal affective disorder, and cognitive impairment (Cuomo et al., 2019). Symptoms of
vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development.
A vitamin D level can be measured via the 25-hydroxy vitamin D blood test. A normal
level is between 20-50 ng/mL. A level less than 12 ng/mL indicates a deficiency.
Toxicology Screen - ANS ✓When diagnosing psychiatric conditions, providers may use
toxicology screenings to rule out substance use as a cause for symptoms. Toxicology
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screenings are also used before starting therapy involving controlled substances, to monitor
medication adherence, and in the diagnosis of substance use disorder.
Urinalysis (UA) - ANS ✓Urinary tract infections are associated with a variety of
neuropsychiatric symptoms (Lee et al., 2019). When clients present with acute mental status
changes, a urinalysis may be used to rule out a urinary tract infection as the cause.
Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. A referral for treatment of hypothyroidism is required. Client can be
reevaluated for fatigue if symptoms persist after hypothyroid treatment has been
initiated, TSH levels are within normal limits.
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%.
A) Begin Treatment
B) Refer - ANS ✓A) Begin treatment.
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
Terri is a 79-year old who presents with confusion. She has positive urine leukocyte
esterase.
A) Begin treatment
B) Refer - ANS ✓B)Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract
infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Julio is a 66-year-old who presents with depression. His vitamin D level 11 ng/mL.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP
may refer or treat vitamin D deficiency depending on the level of comfort of the
provider.
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. Client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
NR 547
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NR 547/ NR547 MIDTERM EXAM DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH GUIDE|
QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS) (NEW 2025/ 2026 UPDATE) -
CHAMBERLAIN
Comprehensive Metabolic Panel (CMP) - ANS ✓The CMP is another common blood test
used to determine general health status. The CMP includes several tests that provide
information about fluid and electrolyte balance as well as the status of the body's metabolism,
liver function, and kidney function. In psychiatric care, the CMP may be used to rule out
medical conditions that could cause symptoms such as changes in mood or cognition. The
CMP is also used to monitor the effects of medications, such as antipsychotics, on liver
function and glucose levels.
Normal CMP Levels
Electrolytes
Sodium (Na+):
Postassium (K+):
Chloride (Cl-):
Bicarbonate (HCO3-): - ANS ✓Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Normal CMP levels
Misc.
Calcium, serum (Ca 2+)
Glucose, serum Fasting:
2-h postprandial:
Cholesterol, serum:
Total Protein
Albumin - ANS ✓Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl;
2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
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Kidney Tests
Creatinine, serum
Urea nitrogen, serum (BUN) - ANS ✓Creatinine, serum 0.6-1.2mg/dl
Urea nitrogen, serum (BUN) 7-18mg/dl
Liver Tests
Alanine aminotransferase (ALT), serum:
Aspartate aminotransferase (AST),
Bilirubin, serum (adult) Total//Direct:
Phosphatase (alkaline), serum: - ANS ✓Liver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
Phosphatase (alkaline), serum: 20-70 U/L
Normal TFT levels
TSH:
T3:
T4: - ANS ✓Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Vitamin B12 Level - ANS ✓Providers may choose to check vitamin B12 levels. Deficiency
of vitamin B12 can affect mood and other brain functions. Common psychiatric symptoms
associated with B12 deficiency include depression, mania, psychotic symptoms, and
cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL
indicates a borderline level with a possible need for additional testing.
Vitamin D Level - ANS ✓Vitamin D affects functions such as neurotransmission,
neuroprotection, and neuroimmunomodulation. Studies have indicated a high prevalence of
vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression,
seasonal affective disorder, and cognitive impairment (Cuomo et al., 2019). Symptoms of
vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development.
A vitamin D level can be measured via the 25-hydroxy vitamin D blood test. A normal
level is between 20-50 ng/mL. A level less than 12 ng/mL indicates a deficiency.
Toxicology Screen - ANS ✓When diagnosing psychiatric conditions, providers may use
toxicology screenings to rule out substance use as a cause for symptoms. Toxicology
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screenings are also used before starting therapy involving controlled substances, to monitor
medication adherence, and in the diagnosis of substance use disorder.
Urinalysis (UA) - ANS ✓Urinary tract infections are associated with a variety of
neuropsychiatric symptoms (Lee et al., 2019). When clients present with acute mental status
changes, a urinalysis may be used to rule out a urinary tract infection as the cause.
Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. A referral for treatment of hypothyroidism is required. Client can be
reevaluated for fatigue if symptoms persist after hypothyroid treatment has been
initiated, TSH levels are within normal limits.
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%.
A) Begin Treatment
B) Refer - ANS ✓A) Begin treatment.
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
Terri is a 79-year old who presents with confusion. She has positive urine leukocyte
esterase.
A) Begin treatment
B) Refer - ANS ✓B)Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract
infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Julio is a 66-year-old who presents with depression. His vitamin D level 11 ng/mL.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP
may refer or treat vitamin D deficiency depending on the level of comfort of the
provider.
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
A) Begin Treatment
B) Refer - ANS ✓B) Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. Client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
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